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Proposed Rule on CO-OP Program Needs Changes
PCMH Should Serve as Foundation of CO-OPs, Says Academy
By News Staff
"The AAFP strongly urges CMS to fully incorporate the patient-centered medical home concept into the CO-OP program," said (then) AAFP Board Chair Lori Heim, M.D., of Vass, N.C., in a letter (3-page PDF; About PDFs) sent last month to CMS Administrator Donald Berwick, M.D. "As CMS evaluates CO-OP grant applications, we urge the agency to consider that the reduction in the growth of health care costs, decreased mortality rates, and improved participation in preventive and screening services are some of the many benefits of the patient-centered medical home."
In the letter, which constitutes the Academy's response to the proposed rule from CMS (14-page PDF; About PDFs) on the program, Heim also noted that changes to antitrust regulations and to Stark self-referral regulations need to be explored to allow physicians, especially those practicing in small- and medium-sized practices, to fully participate in the CO-OP program.
"CO-OPs, as designed, should significantly increase competition through self-regulation of price gouging by facilities, health systems, labs and (sub)specialists while promoting patient-centered care," said Heim. "The AAFP believes that physicians need clear guidelines on how to satisfy (Federal Trade Commission) policy as greater integration is pursued."
Antitrust laws should not create barriers that inhibit clinical integration, she added.
The AAFP also urged CMS to specify that CO-OP operational boards place primary care physicians in the top leadership positions to ensure that CO-OPs are primary care-driven. "Significant and equitable representation from primary care and specialty physicians in a CO-OP's administrative structure, policy development and decision-making processes will help to ensure the program's success," said Heim.
PCMH Should Play Role as Health Insurance Cooperatives Are Established, Says AAFP